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Reviews on Environmental Health

Editor-in-Chief: Carpenter, David O. / Sly, Peter

Editorial Board: Brugge, Doug / Edwards, John W. / Field, R.William / Garbisu, Carlos / Hales, Simon / Horowitz, Michal / Lawrence, Roderick / Maibach, H.I. / Shaw, Susan / Tao, Shu / Tchounwou, Paul B.

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Volume 29, Issue 3


Irritant contact dermatitis

Iris S. Ale
  • Corresponding author
  • Department of Allergology and Department of Dermatology, University Hospital, Republic University of Uruguay, Arazati 1194 11300, Montevideo, Uruguay
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Howard I. Maibach
  • Department of Dermatology, School of Medicine, University of California in San Francisco, San Francisco, CA, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-10-02 | DOI: https://doi.org/10.1515/reveh-2014-0060


Irritant contact dermatitis (ICD) is the most common form of contact dermatitis. It represents the cutaneous response to the toxic/physical effects of a wide variety of environmental agents. Nowadays, it is recognized that irritancy does not represent a single monomorphous entity but rather a complex biologic syndrome with diverse pathophysiology and clinical manifestations. The clinical presentation is highly variable depending on several factors, including properties and strength of the irritant, dose, duration and frequency of exposure, environmental factors, and skin susceptibility. The pathophysiological mechanism depends on activation of the innate immune system and involves skin barrier disruption, cellular changes, and release of proinflammatory mediators that directly recruit and activate T lymphocytes. The diagnosis of irritant contact dermatitis is often clinical, and involves a comprehensive history and examination, as well as the exclusion of allergic contact dermatitis with patch testing. Recent advances in understanding the pathogenesis as well as better awareness of the clinical significance of ICD will lead to a improved care for our patients.

Keywords: contact dermatitis; cutaneous toxicity; irritancy; irritant contact dermatitis; irritants


  • 1.

    Mathias CGT. Contact dermatitis and workers’ compensation: criteria for establishing occupational causation and aggravation. J Am Acad Dermatol 1989;20:842–8.CrossrefPubMedGoogle Scholar

  • 2.

    Mathias CG, Maibach HI. Dermatotoxicology monographs I. Cutaneous irritation: factors influencing the response to irritants. Clin Toxicol 1978;13:333–46.PubMedCrossrefGoogle Scholar

  • 3.

    Wigger-Alberti W, Elsner P. Contact dermatitis due to irritation. In: Kanerva L, Elsner P, Wahlberg JE, Maibach HI, editors. Handbook of occupational dermatology. New York: Springer-Verlag, 2000:99–110.Google Scholar

  • 4.

    Baadsgaard O, Wang T. Immune regulation in allergic and irritant skin reactions. Int J Dermatol 1991;30:161–72.PubMedCrossrefGoogle Scholar

  • 5.

    Levin CY, Maibach HI. Irritant contact dermatitis: is there an immunologic component? Int Immunopharmacol 2002;2:183–9.CrossrefPubMedGoogle Scholar

  • 6.

    Ale SI, Maibach HI. Mechanisms of allergic and irritant contact dermatitis. In: Zhai H, Wilhelm KP, Maibach HI, editors. Dermatotoxicology, 7th ed. Boca Raton, Florida: CRC Press, 2007:159–66.Google Scholar

  • 7.

    Matzinger P. Tolerance, danger, and the extended family. Annu Rev Immunol 1994;12:991–1045.PubMedCrossrefGoogle Scholar

  • 8.

    Matzinger P. The danger model: a renewed sense of self. Science 2002;296:301–5.CrossrefGoogle Scholar

  • 9.

    Janeway CA Jr, Medzhitov R. Innate immune recognition. Annu Rev Immunol 2002;20:197–216.CrossrefPubMedGoogle Scholar

  • 10.

    Fukata M, Vamadevan AS, Abreu MT. Toll-like receptors (TLRs) and Nod-like receptors (NLRs) in inflammatory disorders. Semin Immunol 2009;21:242–53.PubMedCrossrefGoogle Scholar

  • 11.

    Chen G, Shaw MH, Kim YG, Nunez G. NOD-like receptors: role in innate immunity and inflammatory disease. Annu Rev Pathol 2009;4:365–98.CrossrefPubMedGoogle Scholar

  • 12.

    Martinon F, Mayor A, Tschopp J. The inflammasomes: guardians of the body. Annu Rev Immunol 2009;27:229–65.CrossrefPubMedGoogle Scholar

  • 13.

    Freudenberg MA, Esser PR, Jakob T, Galanos C, Martin SF. Innate and adaptive immune responses in contact dermatitis: analogy with infections. G Ital Dermatol Venereol 2009;144: 173–85.PubMedGoogle Scholar

  • 14.

    Lambrecht BN, Leung D-YM. Initiation and maintenance of allergic inflammation: team work at the interface of innate and adaptive immunity. Curr Opin Immunol 2011;23:769–71.CrossrefGoogle Scholar

  • 15.

    Martin SF, Jakob T. From innate to adaptive immune responses in contact hypersensitivity. Curr Opin Allergy Clin Immunol 2008;8:289–93.PubMedCrossrefGoogle Scholar

  • 16.

    Edele F, Esser PN, Lass C, Laszczyk MN, Oswald E, et al. Innate and adaptive immune responses in allergic contact dermatitis and autoimmune skin diseases. Inflamm Allergy Drug Targets 2007;6:236–44.PubMedGoogle Scholar

  • 17.

    Zhang L, Tinkle SS. Chemical activation of innate and specific immunity in contact dermatitis. J Invest Dermatol 2000;115: 168–76.PubMedCrossrefGoogle Scholar

  • 18.

    Ale SI, Maibach HI. Immunologic mechanisms in allergic and irritant contact dermatitis. Dermatotoxicology, 8th ed. London, England: Informa Books, 2012:104–7.Google Scholar

  • 19.

    Dearman RJ, Cumberbatch M, Portsmouth C, Maxwell G, Basketter DA, et al. Synergistic effects of chemical insult and toll-like receptor ligands on dendritic cell activation. Toxicol In Vitro 2008;22:1927–34.PubMedCrossrefGoogle Scholar

  • 20.

    Basketter DA, Kan-King-Yu D, Dierkes P, Jowsey IR. Does irritation potency contribute to the skin sensitization potency of contact allergens? Cutan Ocul Toxicol 2007;26:279–86.CrossrefGoogle Scholar

  • 21.

    Cumberbatch M, Dearman RJ, Groves RW, Antonopoulos C, Kimber I. Differential regulation of epidermal Langerhans cell migration by interleukins (IL)-1 alpha and IL-1 beta during irritant- and allergen-induced cutaneous immune responses. Toxicol Appl Pharmacol 2002;182:126–35.Google Scholar

  • 22.

    Hunziker T, Brand CU, Kapp A, Waelti ER, Braathen LR. Increased levels of inflammatory cytokines in human skin lymph derived from sodium lauryl sulphate-induced contact dermatitis. Br J Dermatol 1992;127:254–7.PubMedCrossrefGoogle Scholar

  • 23.

    Enk AH, Katz SI. Early molecular events in the induction phase of contact sensitivity. Proc Natl Acad Sci USA 1992;89:1398–402.CrossrefGoogle Scholar

  • 24.

    Groves RW, Allen MH, Ross EL, Barker JN, MacDonald DM. Tumour necrosis factor alpha is proinflammatory in normal human skin and modulates cutaneous adhesion molecule expression. Br J Dermatol 1995:132:345–52.Google Scholar

  • 25.

    Davis JA, Visscher MO, Wickett RR, Hoath SB. Influence of tumour necrosis factor-α polymorphism-308 and atopy on irritant contact dermatitis in healthcare workers. Contact Dermatitis 2010;63:320–32.CrossrefPubMedGoogle Scholar

  • 26.

    Piguet PF, Grau GE, Hauser C, Vassali P. Tumour necrosis factor is a critical mediator in hapten induced irritant and contact hypersensitivity reactions. J Exp Med 1991;173:673–9.PubMedCrossrefGoogle Scholar

  • 27.

    de Jongh CM, John SM, Bruynzeel DP, Calkoen F, van Dijk FJ, et al. Cytokine gene polymorphisms and susceptibility to chronic irritant contact dermatitis. Contact Dermatitis 2008;58:269–77.PubMedGoogle Scholar

  • 28.

    Berg EL, Yoshino T, Rott LS, Robinson MK, Warnock RA, et al. The cutaneous lymphocyte antigen is a skin lymphocyte homing receptor for the vascular lectin endothelial cell-leukocyte adhesion molecule 1. J Exp Med 1991;174:1461–6.CrossrefGoogle Scholar

  • 29.

    Eberhard Y, Ortiz S, Ruiz Lascano A, Kuznitzky R, Serra HM. Up-regulation of the chemokine CCL21 in the skin of subjects. exposed to irritants. BMC Immunol 2004;26:7.Google Scholar

  • 30.

    Chew A, Maibach HI. Ten genotypes of irritant contact dermatitis. In: Chew A, Maibach HI, editors. Irritant contact dermatitis. Berlin: Springer Verlag, 2006:5–9.Google Scholar

  • 31.

    Bruze M, Fregert S, Gruvberger B. Chemical skin burns. In: Kanerva L, Elsner P,Wahlberg JE, Maibach HI, editors. Handbook of occupational dermatology. Berlin: Springer, 2000:325–32.Google Scholar

  • 32.

    Malten KE, den Arend JA, Wiggers RE. Delayed irritation: hexanediol diacrylate and butanediol diacrylate. Contact Dermatitis 1979;5:178–84.CrossrefGoogle Scholar

  • 33.

    Nethercott JR, Gupta S, Rosen C, Enders LJ, Pilger CW. Tetraethylene glycol diacrylate. A cause of delayed cutaneous irritant reaction and allergic contact dermatitis. J Occup Med 1984;26:513–6.PubMedGoogle Scholar

  • 34.

    Lammintausta K, Maibach HI, Wilson D. Mechanisms of subjective (sensory) irritation. Propensity to non-immunologic contact urticaria and objective irritation in stingers. Dermatosen Beruf Umwelt 1988;36:45–9.Google Scholar

  • 35.

    Willis CM, Shaw S, De Lacharrière O, Baverel M, Reiche L, et al. Sensitive skin: an epidemiological study. Br J Dermatol 2001;145:258–63.CrossrefPubMedGoogle Scholar

  • 36.

    Amin S, Baran R, Maibach HI. Sensitive skin: what is it? In: Baran R, Maibach HI, editors. Textbook of cosmetic dermatology. London: Martin Dunitz, 1998:343–9.Google Scholar

  • 37.

    Charbonnier V, Morrison BM Jr, Paye M, Maibach HI. Subclinical, non-erythematous irritation with an open assay model (washing): sodium lauryl sulfate (SLS) versus sodium laureth sulfate (SLES). Food Chem Toxicol 2001;39:279–86.CrossrefPubMedGoogle Scholar

  • 38.

    Charbonnier V, Morrison BM Jr, Paye M, Maibach HI. An open assay model to induce subclincal non-erythematous irritation. Contact Dermatitis 2000;42:207–11.CrossrefPubMedGoogle Scholar

  • 39.

    Mathias CG. Post-traumatic eczema. Dermatol Clin 1988;6:35–42.PubMedGoogle Scholar

  • 40.

    McMullen E, Gawkrodger DJ. Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis. Br J Dermatol 2006;154:154–6.PubMedCrossrefGoogle Scholar

  • 41.

    Akimoto K, Yoshikawa N, Higaki Y, Kawashima M, Imokawa G. Quantitative analysis of stratum corneum lipids in xerosis and asteatotic eczema. J Dermatol 1993;20:1–6.PubMedGoogle Scholar

  • 42.

    Horii I, Nakayama Y, Obata M, Tagami H. Stratum corneum hydration and amino acid content in xerotic skin. Br J Dermatol 1989;121:587–92.CrossrefPubMedGoogle Scholar

  • 43.

    Ancona AA. Occupational acne. Occup Med 1986;1:229–43.PubMedGoogle Scholar

  • 44.

    Farkas J. Oil acne from mineral oil among workers making prefabricated concrete panels. Contact Dermatitis 1982;8:141.CrossrefGoogle Scholar

  • 45.

    Das M, Misra MP. Acne and folliculitis due to diesel oil. Contact Dermatitis 1988;18:120–1.PubMedCrossrefGoogle Scholar

  • 46.

    Ju Q, Zouboulis CC, Xia L. Environmental pollution and acne: Chloracne. Dermatoendocrinol. 2009;1:125–8.PubMedGoogle Scholar

  • 47.

    Coenraads PJ, Tang NJ. Chloracne. Contact Dermatitis 2005;53:123.PubMedCrossrefGoogle Scholar

  • 48.

    Violante FS, Milani S, Malenchini G, Barbieri A. Chloracne due to o-dichlorobenzene in a laboratory worker. Contact Dermatitis 2005;52:108.CrossrefGoogle Scholar

  • 49.

    Yamamoto O, Tokura Y. Photocontact dermatitis and chloracne: two major occupational and environmental skin diseases induced by different actions of halogenated chemicals. J Dermatol Sci 2003;32:85–94.CrossrefPubMedGoogle Scholar

  • 50.

    Chew AL, Maibach HI. Occupational issues of irritant contact dermatitis. Int Arch Occup Environ Health 2003;76:339–46.PubMedCrossrefGoogle Scholar

  • 51.

    Björkner BE. Industrial airborne dermatoses. Dermatol Clin 1994;12:501–9.PubMedGoogle Scholar

  • 52.

    Sertoli A, Francalanci S, Giorgini S. Fiberglass dermatitis. In: Kanerva L, Elsner P, Wahlberg JE, Maibach HI, editors. Handbook of occupational dermatology. Berlin: Springer, 2000:122–34.Google Scholar

  • 53.

    Visser MJ, Landeck L, Campbell LE, McLean WH, Weidinger S, et al. Impact of atopic dermatitis and loss-of-function mutations in the filaggrin gene on the development of occupational irritant contact dermatitis. Br J Dermatol 2013;168:326–32.CrossrefPubMedGoogle Scholar

  • 54.

    Landeck L, Visser M, Skudlik C, Brans R, Kezic S, et al. Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy. Br J Dermatol 2012;167:1302–9.PubMedCrossrefGoogle Scholar

  • 55.

    Allen MH, Wakelin SH, Holloway D, Lisby S, Baadsgaard O, et al. Association of TNFA gene polymorphism at position 308 with susceptibility to irritant contact dermatitis. Immunogenetics 2000;51:201–5.CrossrefPubMedGoogle Scholar

  • 56.

    Landeck L, Visser M, Kezic S, John SM. Impact of tumour necrosis factor-α polymorphisms on irritant contact dermatitis. Contact Dermatitis 2012;66:221–7.PubMedCrossrefGoogle Scholar

  • 57.

    Landeck L, Visser M, Kezic S, John SM. IL1A-889 C/T gene polymorphism in irritant contact dermatitis. J Eur Acad Dermatol Venereol 2013;27:1040–3.Google Scholar

  • 58.

    Kezic SI, Visser MJ, Verberk MM. Individual susceptibility to occupational contact dermatitis. Ind Health. 2009;47:469–78.CrossrefPubMedGoogle Scholar

  • 59.

    Ale SI, Maibach HI. Operational definition of occupational allergic contact dermatitis. In: Kanerva L, Elsner P, Wahlberg JE, Maibach HI, editors. Handbook of occupational dermatology. Berlin, New York, Heidelberg: Springer, 2000:344–51.Google Scholar

  • 60.

    Ale SI, Maibach HI. Diagnostic approach in allergic and irritant contact dermatitis. Expert Rev Clin Immunol 2010;6:291–310.CrossrefGoogle Scholar

  • 61.

    Saary J, Qureshi R, Palda V, DeKoven J, Pratt M, et al. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 2005;53:845–55.PubMedGoogle Scholar

  • 62.

    Choi JM, Lee JY, Cho BK. Chronic irritant contact dermatitis: recovery time in man. Contact Dermatitis 2000;42:264–9.CrossrefPubMedGoogle Scholar

  • 63.

    Lee JY, Effendy I, Maibach HI. Acute irritant contact dermatitis: recovery time in man. Contact Dermatitis 1997;36:285–90.CrossrefPubMedGoogle Scholar

  • 64.

    Ellenbecker MJ. Engineering controls as an intervention to reduce worker exposure. Am J Ind Med 1996;29:303–307.PubMedCrossrefGoogle Scholar

  • 65.

    Klotz A, Veeger M, Rocher W. Skin cleansers for occupational use: testing the skin compatibility of different formulations. Int Arch Occup Environ Health 2003;76:367–73.CrossrefGoogle Scholar

  • 66.

    Ortonne J-P. Skin cleansing: an important problem in occupational dermatology. Wiener Med Wochenschr 1990;108:19–21.Google Scholar

  • 67.

    Bauer A, Schmitt J, Bennett C, Coenraads PJ, Elsner P, et al. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database Syst Rev 201016;CD004414.Google Scholar

  • 68.

    Levin Ch, Bashir SJ, Maibach HI. Treatment of irritant contact dermatitis. In: Chew A, Maibach HI, editors. Irritant contact dermatitis. Berlin: Springer Verlag, 2006:461–8.Google Scholar

  • 69.

    Levin C, Zhai H, Bashir S, Chew AL, Anigbogu A, et al. Efficacy of corticosteroids in acute experimental irritant contact dermatitis? Skin Res Technol 2001;7:214–8.PubMedCrossrefGoogle Scholar

  • 70.

    Le TK, DeMon P, Schalkwijk J, van der Valk PG. Effect of a topical corticosteroid, a retinoid and a vitamin D3 derivative on sodium dodecyl sulphate induced skin irritation. Contact Dermatitis 1997;37:19–26.Google Scholar

  • 71.

    Clemmensen A, Andersen F, Petersen TK, Hagberg O, Andersen KE. Applicability of an exaggerated forearm wash test for efficacy testing of two corticosteroids, tacrolimus and glycerol, in topical formulations against skin irritation induced by two different irritants. Skin Res Technol 2011;17:56–62.PubMedCrossrefGoogle Scholar

  • 72.

    Fuchs M, Schliemann-Willers S, Heinemann C, Elsner P. Tacrolimus enhances irritation in a 5-day human irritancy in vivo model. Contact Dermatitis 2002;46:290–4.CrossrefGoogle Scholar

  • 73.

    Engel K, Reuter J, Seiler C, Schulte Mönting J, Jakob T, et al. Anti-inflammatory effect of pimecrolimus in the sodium lauryl sulphate test. J Eur Acad Dermatol Venereol 2008;22:447–50.CrossrefPubMedGoogle Scholar

  • 74.

    Rosen K, Mobacken H, Swanbeck G. Chronic eczematous dermatitis of the hands. a comparison of PUVA and UVB treatment. Acta Dermato Venereologica (Stockh) 1987;67:48–54.Google Scholar

  • 75.

    Hahn GH. Strontium is a potent and selective inhibitor of sensory irritation. Dermatol Surg 1999;25:689–94.CrossrefGoogle Scholar

About the article

Corresponding author: Iris S. Ale, Department of Allergology and Department of Dermatology, University Hospital, Republic University of Uruguay, Arazati 1194 11300, Montevideo, Uruguay, Phone: +(598) 98786141, E-mail:

Received: 2014-08-11

Accepted: 2014-08-13

Published Online: 2014-10-02

Published in Print: 2014-08-01

Citation Information: Reviews on Environmental Health, Volume 29, Issue 3, Pages 195–206, ISSN (Online) 2191-0308, ISSN (Print) 0048-7554, DOI: https://doi.org/10.1515/reveh-2014-0060.

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